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ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2008, Number 3

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An Med Asoc Med Hosp ABC 2008; 53 (3)

Effect of ephedrine over the timing of action of neuromuscular block by use of ED95 rocuronium/mivacurium

Calderón HC, Guzmán NR, Olivares MH, Espíritu MS, Gutiérrez GA, Montañez RH, Pérez-García EA

Language: Spanish
References: 42
Page: 132-137
PDF size: 148.69 Kb.


ABSTRACT

The time from loss of consciousness to tracheal intubation is usually determined by the establishment of neuromuscular block and by the speed at which these drugs reach the neuromuscular junction. The interaction of combination rocuronium and mivacurium is the result of synergistic action, since ephedrine can increase these variables. Methods: A study of 20 adult patients with ASA I/II physical status. Response was registered by adductor pollicis by stimulation of cubital nerve. No pre-medication was given. Anesthesia was induced with fentanyl 2 µg/kg followed by propofol 2 mg/kg. Patients were randomly assigned to receive either saline (group I) or ephedrine 70 µg/kg (group II) before propofol. Rocuronium 300 µg/kg and mivacurium 80 µg/kg were given afterward. Results: No differences in demographic data were found between both groups. Intubation conditions were evaluated from good to excellent in all patients, without relevant differences. The time of onset was significantly shorter in group II. Ephedrine administration was not associated to significant changes in heart rate of medial blood pressure. No arrhythmias were reported during the study. Conclusions: Ephedrine reduced the onset of time for the combination of rocuronium and mivacurium with no significant adverse effects.


REFERENCES

  1. Donati F. Onset of action of relaxants. Can J Anaesth 1988; 35: 552-558.

  2. Cohn JN. Comparative cardiovascular effects of tyramine, ephedrine, and norepinephrine in man. Cir 1965; 16: 174-182.

  3. Wepierre J, Cohen Y, Valette G. Action vasculaire de l’ephédrine dans les territoires musculaires et mésenterique. Arch Int Pharmacodyn 1970; 185: 34–46.

  4. Santiveri X, Mansilla R, Pardina B, Navarro J, Álvarez JC, Castillo J. La efedrina acorta el inicio de acción del rocuronio pero no del atracurio. Rev Esp Anestesiol Reanim 2003; 50: 176-181.

  5. Savarese JJ, Ali HH Basta SJ, Embree PB, Scott RPF, Sunder N, Weakly JN, Wastila WB, El-Sayad HA. The clinical neuromuscular pharmacology of mivacurium chloride administered to patients during oxygen-sufentanil anesthesia for coronary artery bypass grafting or valve replacement. Anesth Analg 1994; 78: 318-326.

  6. Stoops CM, Curtis CA, Kovach DA et al. Hemodynamic effects of mivacurium chloride administered to patients during oxygen-sufentanil anesthesia for coronary artery bypass grafting or valve replacement. Anesth Analg 1989; 68: 333-338.

  7. Levy JH, Davis GK, Duggan J, Szalm F. Determination of the hemodynamics and histamine release of rocuronium (ORG 9426) when administered in increased doses under N2O/O2 sufentanil anesthesia. Anesth Analg 1994; 78: 318-321.

  8. Savarese JJ, Ali HH, Basta SJ, Scott RP, Embree PB, Wastila WB et al. The cardiovascular effects of mivacurium chloride (BW B1090U) in patients receiving nitrous oxide-opiate-barbiturate anesthesia. Anesthesiology 1989; 70: 386-394.

  9. Naguib MB. Neuromuscular effects of rocuronium bromide and mivacurium chloride administered alone and in combination. Anesthesiology 1994; 81: 388-395.

  10. Naguib M. Different priming techniques, including mivacurium, accelerate the onset of rocuronium. Can J Anaesth 1994; 41: 902-907.

  11. Stevens JB, Shepherd JM, Vories PA et al. Rapid sequence induction of anesthesia with a combination of rocuronium and mivacurium. Anesthesiology 1995; 83: 912-919.

  12. Waud BE, Waud DR. Quantitative examination of the interaction of competitive neuromuscular blocking agents on the indirectly elicited twitch. Anesthesiology 1984; 61: 420-427.

  13. Naguib M, Abdulatif M. Isobolographic and dose-response analysis of the interaction between pipecuronium and vecuronium in surgical patients. Br J Anaesth 1993; 71; 556-560.

  14. Lebowitz PW, Ramsey FM, Savarese JJ, Ali HH. Potentiation of neuromuscular blockade in man produced by combinations of pancuronium and metocurine or pancuronium and d-tubocuranine. Anesth Analg 1980; 59: 604-609.

  15. Waud BE, Waud DR. Interaction among agents that block endplate depolarization competitively. Anesthesiology 1985; 63: 4-15.

  16. Zaritsky AL, Chernow B. Catecholamines, sympathomimetics. In: Ziegler MG, Lake CR (eds): Frontiers of clinical neuroscience. Baltimore: Williams & Wilkins; 1984; vol 2 (Norepinephrine). p. 481.

  17. Ramanathan S, Grant G, Turndorf H. Cardiac preload changes with ephedrine therapy for hypotension in obstetrical patients. Anesth Analg 1986; 65: 125-130.

  18. Stanton-Hicks M, Hock A, Stuhmeier K, Arndt JO. Venoconstrictor agents mobilize blood from different sources and increase intrathoracic filling during epidural anesthesia in supine humans. Anesthesiology 1987; 66: 317-323.

  19. Ramanathan S, Grant GJ. Vasopressor therapy for hypotension due to epidural anesthesia for cesarean section. Acta Anaesthesiol Scand 1988; 32: 1-9.

  20. Zaimis E. Vasopressor drugs and catecholamines. Anesthesiology 1968; 29: 732-737.

  21. Smith NT, Corbascio AN. The use and misuse of pressor agents. Anesthesiology 1970; 8: 58-62.

  22. Smith CE, Donati F, Bevan DR. Differencial effects of pancuronium on masseter and adductor pollicis muscles in humans. Anesthesiology 1989; 71: 57-61.

  23. Donati F, Plaud B, Meistelman C. Vecuronium neuromuscular blockade at the adductor muscle of the larynx and the adductor pollicis. Anesthesiology 1991; 74: 833-837.

  24. Pansard JL, Chauvin M, Lebreault C et al. Effect of an intubating dose of succinylcholine and atracurium on the diaphragm and adductor pollicis muscle in humans. Anesthesiology 1987; 67: 326-330.

  25. Bartowski RR. Incomplete reversal of pancuronium neuromuscular blockade by neostigmine, pyridostigmine and edrophonium. Anesth Analg 1987; 66: 594-598.

  26. Beemer GH, Bjorksten AR, Dawson PJ et al. Determinants of the reversal time of competitive neuromuscular block by anticholinesterases. Br J Anesth 1991; 66: 469-474.

  27. Waud BE, Waud DR. The relation between tetanic fade and receptor occlusion in the presence of competitive neuromuscular block. Anesthesiology 1971; 35: 456-461.

  28. Mogorian T, Flannery KB Miller RD. Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology 1993; 79: 913-918.

  29. Lee C. Succinylcholine update. Curr Opin Anaesthesiol 1993; 6: 709-714.

  30. Hunter JM. Rocuronium: The newest aminosteroid neuromuscular blocking drug. Br J Anaesth 1996; 76: 481-483.

  31. Foldes FF. Rapid tracheal intubation with nondepolarizing neuromuscular blocking drugs: The priming principle. Br J Anaesth 1984; 56: 663-669.

  32. Schwartz S, llias W, Lackner F et al. Rapid tracheal intubation with vecuronium: the priming principle. Anesthesiology 1985; 62: 388-391.

  33. Mehta MP, Choy W, Gergis SD et al. Facilitation of rapid sequence endotracheal intubations with divided doses of nondepolarizing neuromuscular blocking drugs. Anesthesiology 1985; 62: 392-395.

  34. Rorvik K, Husby P, Gramstad L et al. Comparison of large dose of vecuronium with pancuronium for prolonged neuromuscular blockade. Br J Anaesth 1988; 61: 180-185.

  35. Ginsberg B, Glass PS, Quill T et al. Onset and duration of neuromuscular blockade following high-dose vecuronium administration. Anesthesiology 1989; 71: 201-205.

  36. Harrison GA, Junius F. Effects of circulation time on the neuromuscular action of suxamethonium. Anesth Intensive Care 1972; 1: 33-40.

  37. Goat VA, Yeung ML, Blakeney C, Feldman SA. The effect of blood flow upon the activity of gallamine triethiodide. Br J Anaesth 1976; 48: 69-73.

  38. Kopman AF. Onset of action of neuromuscular blockade: contributing factors. Curr Opin Anaesthesiol 1992; 5: 561-567.

  39. Gill RS, Scott RPF. Etomidate shortens the onset time of neuromuscular block. Br J Anaesth 1992; 69: 444-446.

  40. Gamlin F, Vucevic M, Winslow L, Berridge J. The Haemodynamic effects of propofol in combination with ephedrine. Anaesthesia 1996; 51: 488-491.

  41. Pollard BJ, Jones RM. Interactions between tubocuranine, pancuronium and alcuronium demonstrated in the rat phrenic nerve hemidiaphragm preparation. Br J Anaesth 1983; 55: 1127-1130.

  42. El-Beheiry H, Kim J, Milne B, Seegobin R. Prophylaxis against the systemic hypotension induced by propofol during rapid sequence intubation. Can J Anaesth 1995; 42: 875-878.




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